THE TOUGH CUSTOMER- French reflection: UVA unbending in back injury case

For a few months, I've been following the plight of Judy Adams with increasing interest.

Adams is the woman who broke her back in a car accident on the first day of her vacation in France last summer. After several days in a French hospital, she was fit with a custom brace, and she and her fiancé, Eddie Mikell, made arrangements to return home.

The hospital in France would not release Adams, however, unless during transport she could remain flat on her back. Getting home cost Adams and Mikell about $13,000– for two ambulance rides and first-class airplane tickets so that Adams could lie flat during the overseas flight.

While they were in France, their dealings with Southern Health, administrator of the UVA health plan that covered Adams, alerted them they might have some problems being reimbursed. So upon landing at Dulles, they went directly to Reston Hospital Center where Doctor Rodney Biglow recommended, in writing, that Adams return to Charlottesville "by stretcher."

Southern Health did, in fact, deny coverage, and Adams and Mikell have diligently followed the plan's appeals procedures. Just this past weekend the UVA health plan ombudsman, Joanne Hayden, wrote them that an external review denied their final appeal under the health plan, although a review by the State of Virginia remains available.

According to Hayden's letter, the review concluded that medical literature states that Adams' type of fracture is "usually stable and rarely associated with neurological problems." Further, an MRI in France found the fracture "was without indication of instability," and most importantly, there was nothing in Adams' hospital records establishing the medical necessity for special transport.

I'm no doctor, but even allowing for the medical accuracy of the external review, it ignores the fact that Adams was ordered to travel supine by three physicians– one in France and two here– who actually examined her.

Furthermore, the lack of documentation from France contradicts what both Adams and Mikell claim they were told, yet there is no indication of any effort to explain this discrepancy. Given that France has a different health care system than the U.S., could the lack of written documentation be due to cultural, not medical, factors?

In addition, the decision says, "There were no orders in the documentation that stated the patient should lie flat," but this is plainly contradicted by Dr. Biglow's recommendation.

UVA spokesperson Carol Wood says she cannot discuss the case due to privacy concerns. UVA's plan is self-funding, so it can presumably cover Adams if it wants to, although Wood says the ombudsman is not empowered to make a decision regarding medical necessity.

"She's there to assist" the employee, not to decide claims, Wood says.

For their part, Adams and Mikell have endured this ordeal with a level of aplomb that includes auctioning off Adams' custom-fitted back brace on eBay. (An Australian couple bought it for $125.)

More happily, Adams and Mikell are getting married– on FM radio, no less. Mikell has some friends at 3WV, and they hit upon the idea of an on-air wedding. A number of the station's sponsors will be assisting: A New Leaf Florist, Chandler's Bakery, Blue Ridge Café, Ambassador Limo, and the Doubletree Hotel are all pitching in.

Adams and Mikell will exchange their vows on this Friday, November 9 at 9am. All are invited to tune in.

"So it looks like this year," Mikell says, "is going to turn out great."